New General Surgery grad to start fellowship July 2009. Looking for some part time work and found some general surgery ER and hospital call at a pretty quiet (I hope) place (100 bed hospital) in the country. Flat fee of $900 for 24 hours and $125/hr for every hour after 2 hours i work per day (they get 2 hours of my time for "free" per day). Does anyone have any experience with this? Is this reasonable payment? Thanks in advance.
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For not being BE/BC in EM, this is not bad pay.
A few things you will want to check out:
-# visits/year in the ED (the size of the hospital is less relevant. Ie, a hospital may be 100 beds but see 50K ED visits a year. Basically, average out how many patients you will be seeing an hour.
-any time you do locums, ask about malpractice (you want it with a tail). If you are having to pay for it, average that into your 'salary'.
-find out how they deal with taxes. If they are paying you a lump sum (no taxes) you will carry a higher tax burden. You will also want to take this into account when you start figuring out how much they will be paying you.
All in all, look at ALL the fine print (and don't forget the malpractice). your 70-80/hour job can rapidly become 40, which may or may not be worth your time.
On the other hand, you could also do some easy consulting, which you can do as you want it, with no need to carry malpractice insurance.
A few things you will want to check out:
-# visits/year in the ED (the size of the hospital is less relevant. Ie, a hospital may be 100 beds but see 50K ED visits a year. Basically, average out how many patients you will be seeing an hour.
-any time you do locums, ask about malpractice (you want it with a tail). If you are having to pay for it, average that into your 'salary'.
-find out how they deal with taxes. If they are paying you a lump sum (no taxes) you will carry a higher tax burden. You will also want to take this into account when you start figuring out how much they will be paying you.
All in all, look at ALL the fine print (and don't forget the malpractice). your 70-80/hour job can rapidly become 40, which may or may not be worth your time.
On the other hand, you could also do some easy consulting, which you can do as you want it, with no need to carry malpractice insurance.
Not bad.
When I did a poll a few years back it seemed that most people averaged between $50 and $75/hour. So when I worked at a nice sleepy hospital I was paid $50/hour but when taxes were taken out, it worked out to be somewhere between $900 and $1000 for a 24 hr shift.
I don't understand the $125 - do you mean for every hour after the first two you get the $900 PLUS $125/hr? OR just if you stay over 24 hrs?😕
And you aren't talking about covering the ER entirely, but just that you are in house for in house patient calls and for ER surgery consults, right? This would be the typical situation as opposed to the situation roja describes (which sounds like working in the ED as an EP).
They provide me with a hotel room a few minutes from the hospital and I am on call as a general surgeon attending for 48 consecutive hours over the weekend (friday night to sunday night), meaning I do the appys or the small bowel obstructions or perforated ulcers myself, I don't call anyone.....so I'm technically not in house but because this place is located 70 miles from where I live, they have provided me with a hotel room for 48 hrs for free and a car for free that is mine to use when I'm on call. I am the attending in a private practise setting.
If I get called into the hospital to do anything (OR, consult, see a patient) the first 2 hours in any 24 hour period are free (covered by the $900) but anything over that I will get reimbursed $125/hr. So if I'm in the hopsital doing 3 appys and 2 consults over 24 hrs which takes me 8 hours, I get paid 900+6*125=$1650. If I'm not doing anything, I get my 900 bucks and I'm studying for my written boards in a hotel room and watching DVDs.
So my basic question: Is this enough reimbursement for the level of responsibility I'm assuming? This is not resident call.....the buck stops with me! (as a surgeon, not ER doctor)
If I get called into the hospital to do anything (OR, consult, see a patient) the first 2 hours in any 24 hour period are free (covered by the $900) but anything over that I will get reimbursed $125/hr. So if I'm in the hopsital doing 3 appys and 2 consults over 24 hrs which takes me 8 hours, I get paid 900+6*125=$1650. If I'm not doing anything, I get my 900 bucks and I'm studying for my written boards in a hotel room and watching DVDs.
So my basic question: Is this enough reimbursement for the level of responsibility I'm assuming? This is not resident call.....the buck stops with me! (as a surgeon, not ER doctor)
I don't like the 2 hour requirement since the hospital is counting on you not spending more than 2 hours on routine consults which is going to be most of what you will be seeing. If the ER doc knows that he/she can pick up the phone and have the locums surgeon come in for 2 hours and it will not cost the hospital bean counters any extra cash, guess what? You are going to get a lot of calls to come and "lay hands" on a lot of patients that otherwise might be taken care of by the ER person. Also, who's going to be the ER doc? Is it going to be a family medicine person making some "easy" w/e cash, or an ER trained physician? It may be that the hospital wants you in place to back up someone marginally qualified who will be calling you non-stop. With the 2 hour exception in there, it sounds like you'll be coming in a lot to do work-ups.
The more I think about it, the better deal it sounds for the hospital. They get a board eligible general surgeon locked in to see 48 hours worth of consults for less than 50 bucks an hour. Wow.
I'd get the hospital to drop the 2 hour exception. Otherwise I'd walk.
Sorry...I misunderstood. For some reason I thought you had the same gig I had when I was a fellow - that is, basically as a resident, with attending coverage.
I agree with Celiac - you are being underpaid (most general surgery attendings I know who took call made around $3000 for the weekend, plus whatever they billed for any surgeries done or consults seen). Flat rate...regardless of whether or not they came in.
In addition, the free two hours is an insult; most consults will not take you that long. If you come in for a total of two hours all through the weekend then you get paid? Or is it two hours each time you come in? Are they paying your malpractice AND the tail? If you have to come in and round on post-op patients, do you get paid for that time, or only if you spend more than two hours doing it?
At any rate, you are being underpaid. In this day and age of places being desparate for general surgery coverage, they can do a LOT better. The reason for the flat rate is that while it sounds great if you never get called in - you can't do anything else. You can't have a drink with dinner, you can't leave the area etc. Pager call is not free.
I'd also negotiate a rate with them that is either much higher or allows you to bill for your consults. Since you are presumably on no insurance plans, the hospital has to pay you what you bill. I'd suggest 2.5 times Medicare, which for a Level 5 consult would be around $550 - for EACH patient you see. If you negotiated that, then a lower flat rate might be acceptable if they also drop the two hour limit.
I agree with Celiac - you are being underpaid (most general surgery attendings I know who took call made around $3000 for the weekend, plus whatever they billed for any surgeries done or consults seen). Flat rate...regardless of whether or not they came in.
In addition, the free two hours is an insult; most consults will not take you that long. If you come in for a total of two hours all through the weekend then you get paid? Or is it two hours each time you come in? Are they paying your malpractice AND the tail? If you have to come in and round on post-op patients, do you get paid for that time, or only if you spend more than two hours doing it?
At any rate, you are being underpaid. In this day and age of places being desparate for general surgery coverage, they can do a LOT better. The reason for the flat rate is that while it sounds great if you never get called in - you can't do anything else. You can't have a drink with dinner, you can't leave the area etc. Pager call is not free.
I'd also negotiate a rate with them that is either much higher or allows you to bill for your consults. Since you are presumably on no insurance plans, the hospital has to pay you what you bill. I'd suggest 2.5 times Medicare, which for a Level 5 consult would be around $550 - for EACH patient you see. If you negotiated that, then a lower flat rate might be acceptable if they also drop the two hour limit.
Please note: the clock starts ticking as soon as I get into my car to see something. If this takes me 45 minutes, it still counts towards the 2 hour minimum. So if I get called in for three 45 minute consults I get paid for the last 15 minutes (minimum time they pay for). Everything after that in that 24 hour period I get paid for--> the clock does not reset to zero when I arrive to the hospital to see something else. So, if they decided to torture me with ten separate 30 minute ER consults in 24 hours, I would be paid (5hrs -2hr)*125+900=1275 for 24 hours work (actually 5 hrs work and 19 hrs of holding the pager). I guess this is still not optimal....perhaps I should just ask them to bump the 24 hr minimum up to 1250 or so.
Thanks all...
Thanks all...
You are still being underpaid, regardless of whether or not the clock starts when you get in the car (are you really staying 45 minutes away) or they don't reset it each and every time.
In the *example* you gave, you are still being paid the same or less than a RESIDENT doing the same work (ie, $1275 for 24 hrs work), AND they get to bill for the Surgery consultation, care, etc. They are keeping all the money for everything you do in the set-up as you describe it.
It sounds like you're really interested in this job and far be it for us to talk you out of it, but you are a BE surgeon and they are paying you non-BE surgery resident rates.
Also remember you have to pay taxes out of that flat rate; its not tax free.
In the *example* you gave, you are still being paid the same or less than a RESIDENT doing the same work (ie, $1275 for 24 hrs work), AND they get to bill for the Surgery consultation, care, etc. They are keeping all the money for everything you do in the set-up as you describe it.
It sounds like you're really interested in this job and far be it for us to talk you out of it, but you are a BE surgeon and they are paying you non-BE surgery resident rates.
Also remember you have to pay taxes out of that flat rate; its not tax free.
Thanks for all the advice.
I was able to get $2200 for 48 hours without the 2 hour free-bee.
I will get reimbursed 125/hr for every hour I work in 15 minute increments.
I was told that they were paying me well by industry standards because they were taking care of my lodging, transportation, malpractise etc.
In addition, the rates were a bit lower because I was going through an agency and not directly through with the hospital.
I was told that this agency routinely pays general surgeons 800 dollars over 24 hours to hold a pager. Is this the difference? the middleman?
I was able to get $2200 for 48 hours without the 2 hour free-bee.
I will get reimbursed 125/hr for every hour I work in 15 minute increments.
I was told that they were paying me well by industry standards because they were taking care of my lodging, transportation, malpractise etc.
In addition, the rates were a bit lower because I was going through an agency and not directly through with the hospital.
I was told that this agency routinely pays general surgeons 800 dollars over 24 hours to hold a pager. Is this the difference? the middleman?
That sounds much better.
Perhaps. Your malpractice working as a BE/BC surgeon would be significantly more than it would be as a resident and may vary state to state.
That may be. Although seemingly 800 dollars for 24 hrs seems low, given that's less than I was making as a resident sleeping for dollars, or "holding a pager." The fees to the agency aren't supposed to affect how much they pay you. All I know is how much I made and what friends in your position (albeit in different states) made.
Bottom line: you can bet they are still making money off you if they anticipate you operating.
Thanks for the update.
45.83 cents per hour for a board eligible general surgeon to cover an ED on the w/e for 48hrs is still poor pay no matter how you look at it. However, with the 2 hour exemption dropped, it's better. Hopefully, you'll be operating as well, and that will bump your pay significantly.
Your "lodging" and car rental probably cost 200 bucks or so for the w/e so that's not much ($4.16 cost averaged over 48 hrs). And malpractice is a fact of life. The hospital is not doing you a favor by paying it. The fact is that no one would take the job for any amount if malpractice was not paid for.
One other thing to discuss before you sign on the dotted line... Make sure that the hospital will reimburse you for surgical services to indigent/uninsured patients. The medicare rate at the very least, and 1.5-2.5x the Medicare rate would be better.
Get ready for people at hospitals, and search firms for the rest of your career telling you what a great deal you're getting, "considering xxx" as they offer you poor/marginal deals. It's just low-level negotiation bluffing. If the agency "routinely" pays a general surgeon $800 to hold the pager for 48 hours, then ask them why they are not doing that for the weekend(s) that they are negotiating for you? "Industry standards"... lol. Clearly that is a transparent pressure tactic. Bottom line is that they need you to keep the ED/hospital operating, not the other way around. You have the high ground in this negotiation, don't give it away.
You haven't mentioned if they are paying your malpractice tail.
You are still making less than what I made as a resident (at $45/hour) but have the potential to make more with the $125/hr for coming in.
And Celiac is correct, industry standards my arse. I'd like to see some general surgeon of any caliber agree to hold a pager all weekend for $800. I wouldn't do it even if I had nothing else to do. The fact that they are paying you more means they *can't* find that fictitious surgeon to do it for their crappy pay.
You are still making less than what I made as a resident (at $45/hour) but have the potential to make more with the $125/hr for coming in.
And Celiac is correct, industry standards my arse. I'd like to see some general surgeon of any caliber agree to hold a pager all weekend for $800. I wouldn't do it even if I had nothing else to do. The fact that they are paying you more means they *can't* find that fictitious surgeon to do it for their crappy pay.
Yes they are covering my malpractise and tail.
The amount I mentioned above was $800 for 24 hours, not the entire weekend.
I agree with everything you have all said.
Please refer to following May 2008 ACS essay about the sad state of locum tenens and the fact that these intermediary agencies make more off an assignment than the surgeons do...and take no risk.
http://www.facs.org/fellows_info/bulletin/2008/tolls0508.pdf
My dealings are with locumtenens.com NOT the hospital, they probably charge the hospital some exorbitant fee to pay the myriad of administrators and paper pushers etc, and then pay me a nominal sum.
Please also note that I trained at a powerhouse southern general surgery program and graduated from a first rate medical shool with excellent references.
I think the issue will be to find an opportunity directly from a hospital bypassing these middlemen.
I have had difficulty finding these opportunities even with the huge shortage of general surgeons.......while CRNAs command $100/hr, even through these locum tenens companies.
I don't know if hospitals post their opportunities directly somewhere....
I'm still looking. If anyone has suggestions to where I could find these better opportunities, I'm all ears.
Thanks again.
The amount I mentioned above was $800 for 24 hours, not the entire weekend.
I agree with everything you have all said.
Please refer to following May 2008 ACS essay about the sad state of locum tenens and the fact that these intermediary agencies make more off an assignment than the surgeons do...and take no risk.
http://www.facs.org/fellows_info/bulletin/2008/tolls0508.pdf
My dealings are with locumtenens.com NOT the hospital, they probably charge the hospital some exorbitant fee to pay the myriad of administrators and paper pushers etc, and then pay me a nominal sum.
Please also note that I trained at a powerhouse southern general surgery program and graduated from a first rate medical shool with excellent references.
I think the issue will be to find an opportunity directly from a hospital bypassing these middlemen.
I have had difficulty finding these opportunities even with the huge shortage of general surgeons.......while CRNAs command $100/hr, even through these locum tenens companies.
I don't know if hospitals post their opportunities directly somewhere....
I'm still looking. If anyone has suggestions to where I could find these better opportunities, I'm all ears.
Thanks again.
For Winged Scapula, or anyone else with experience...
I'm bumping an old thread, but trying to get a sense of what surgery locums world is like and how to gauge what reasonable or fair compensation for BE surgeon is like for locums. I'm in a similar position as the OP. I have had to defer fellowship start last minute due to personal/family emergencies. So now looking at locums. Even now the compensation terms, through an agency, are still the same. $900/24hr call, with an hourly rate (~90-100/hr if you come in). You can't bill for cases done. Malpractice and tail are covered. The IHS are offering NO COMPENSATION for call unless I have to come in, and they're asking to cover 72 hrs of weekend call and no pay to carry the pager, unless you come in, at which point they pay $100/hr. Idk, that just seems like some straight BS.
So how do you gauge what's fair/reasonable compared to what other surgeons are paid vs figuring out whether you're being punked by these agencies? I feel like there's a lot of information on locums for other specialties, but not much out there for surgeons. The ACS article on locums that has been linked in several old threads is no longer active.
I'm bumping an old thread, but trying to get a sense of what surgery locums world is like and how to gauge what reasonable or fair compensation for BE surgeon is like for locums. I'm in a similar position as the OP. I have had to defer fellowship start last minute due to personal/family emergencies. So now looking at locums. Even now the compensation terms, through an agency, are still the same. $900/24hr call, with an hourly rate (~90-100/hr if you come in). You can't bill for cases done. Malpractice and tail are covered. The IHS are offering NO COMPENSATION for call unless I have to come in, and they're asking to cover 72 hrs of weekend call and no pay to carry the pager, unless you come in, at which point they pay $100/hr. Idk, that just seems like some straight BS.
So how do you gauge what's fair/reasonable compared to what other surgeons are paid vs figuring out whether you're being punked by these agencies? I feel like there's a lot of information on locums for other specialties, but not much out there for surgeons. The ACS article on locums that has been linked in several old threads is no longer active.
"no compensation for call"?? That's a load of horse manure. Ask for 5000 for the weekend. They can afford it
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Full disclosure, I've never worked as a locums but I briefly looked into it a few years back. There are good companies and bad companies out there, so make sure to call around and ask questions and make sure they seem competent and helpful.
$900/24h is low from what I know for locums, although it does vary by acuity, hospital size, location (i.e. less in desirable cities, more in rural areas) and whether there is any trauma coverage required (i.e. more $). Weekends pay better than weekdays. If you are unlikely to have to do anything all weekend, $900 is less unreasonable than if covering a busy hospital with numerous sick admits at all hours where you are also expected to deal with traumas. No billing for cases done is ridiculous--they are paying you the same for coming in and doing a consult or rounding as being in the OR, which is completely inappropriate IMO. If the hospital bills the surgeon fee, you should be reimbursed the going rate for a given procedure (i.e. wRVU rate or some equivalent), but you should be told in advance how they calculate this so you can negotiate more favorable terms if they lowball you.
IHS with no compensation unless you come in--No. Just no. Run away and don't look back.
You also need to make sure that all your travel, meals, licensing/DEA, and housing expenses are covered as part of your locums deal for a given job. This should be standard, within reason. Remember that the locums agency will be profiting off of you and will charge the hospital outrageously more than what you get. Most locums agencies are desperate to fill jobs, so you should be able to negotiate terms.
Th
Thanks for your replies.
Figuring out who is good and who is bad, even if just based on asking around has been difficult. I signed with two (based on good referrals from others) but my experience thus far dealing with them hasn't been all that great. As far as negotiating terms, with the IHS, the agency claims that since its government, serving underserved populations, so they can't negotiate the terms. But I'm thinking that if they can pay the agency enough to find a locums, then they should be able to pay for call (especially since they're trying to get folks to go out to locations that are in the middle of nowhere, with no other amenities). And the hospitals are definitely not quiet or sleepy- they see quite a bit of trauma, even for a 50 bed hospital. My overall conclusion thus far- all agencies are shady, and their main goal is to try to low key screw and exploit the surgeon in whatever way to make the most the money. Its worse if you're green to the locums game. Will just start working on trying to find opportunities on my own.
Thanks for your replies.
Figuring out who is good and who is bad, even if just based on asking around has been difficult. I signed with two (based on good referrals from others) but my experience thus far dealing with them hasn't been all that great. As far as negotiating terms, with the IHS, the agency claims that since its government, serving underserved populations, so they can't negotiate the terms. But I'm thinking that if they can pay the agency enough to find a locums, then they should be able to pay for call (especially since they're trying to get folks to go out to locations that are in the middle of nowhere, with no other amenities). And the hospitals are definitely not quiet or sleepy- they see quite a bit of trauma, even for a 50 bed hospital. My overall conclusion thus far- all agencies are shady, and their main goal is to try to low key screw and exploit the surgeon in whatever way to make the most the money. Its worse if you're green to the locums game. Will just start working on trying to find opportunities on my own.
